Under Pressure

Authors: Vazeer Ahmed, Sophie Jefferys / Editor: Adrian Boyle / Reviewer: Rebecca Ford, Sophie Jefferys / Codes: A5, O8 / Published: 28/01/2023

A 59-year-old man presented to Emergency Department (ED) at 11pm with acute onset severe (9/10) generalised headache and vomiting, which started at the dinner table at 5pm. On presentation his BP was 152/87. The initial differential diagnosis included Subarachnoid Haemorrhage. An initial CT was normal.

He is a type 1 insulin dependent diabetic with previous laser treatment for diabetic retinopathy in both eyes (over 25 years ago). He is a known hypertensive with hypercholesterolemia. He also suffers from benign prostatic hypertrophy and decreased bone density. He had cataract surgery in his right eye 11 months ago.

He was reviewed on the Clinical Decision Unit the next morning while awaiting Lumbar Puncture. On examination at 8am he was photophobic, sitting in bed clutching the left side of his face. He complained of orbital pain and associated localised headache.

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